The stark reality of South Africa’s low calcium intake

It is no exaggeration to say that the effects of osteoporosis are crippling – that the causes of it can be effectively curtailed by knowing some simple dietary and lifestyle facts, therefore seems all the more concerning and unnecessarily cruel.

Some disturbing statistics:

  • The average daily intake of calcium in South Africa is approximately 400-500mg/day – only half of the recommended intake of 1000 mg/day
  • Although our beautiful continent has more than sufficient sunshine, Africa registers the highest rate of rickets (a condition that affects bone development in children) worldwide, according to findings provided by the IOF (International Osteoporosis Foundation).
  • The statistics in South Africa alone are worrying: 15% of South African infants suffer from vitamin and mineral deficiencies. A common nutritional problem among South Africans is hypocalcaemia, a deficiency in calcium. A study of a random rural South African community showed that 13.2% of children had abnormally low levels of calcium in their blood. This leads to rickets which causes weakness and pain in bones and eventual skeletal deformities.
  • A South African Youth Risk Behaviour Survey (YRBS) reported that half (49.6%) of the national sample of Grade 8 to 11 adolescents in South Africa had used alcohol. The Western Cape Province had the highest prevalence of current drinkers (53%). Abuse of alcohol reportedly reduces circulating Vitamin D concentrations for the following reasons: 1) the effect of alcohol on Vitamin D absorption; 2) altered biliary secretion; and 3) poor diet. Sufficient vitamin D levels are important for the optimal absorption of calcium.
  • A different study on calcium intake and knowledge among urban adolescent girls in Gauteng, from sixteen randomly selected private and state schools, reflected both insufficient dietary knowledge and intake of calcium, as well as misconceptions concerning dairy products.

Calcium is the dominant mineral in bone: more than 99% of the body’s calcium is contained in the skeleton and teeth. Inadequate intake is dangerous. The active form of Vitamin D is essential for intestinal absorption of calcium.

Some probable reasons:

While malnutrition in certain impoverished geographical areas and socio-economic groups in South Africa continues to be prevalent and contributes to insufficient calcium intake, there are other significant factors which require equal, urgent attention as reasons for calcium deficiency.

  • Many mothers in South Africa do not breastfeed their children to prevent them from contracting AIDS. The substitutes used do not always contain sufficient calcium.
  • In representative samples of adolescents in the Cape Town area, the Vitamin D and calcium status is lowered by heavy alcohol use. It has been proved that alcohol has a significant inverse association with bone mineral density because it has a direct toxic effect on bone
  • Smoking is a major contributor to high cadmium levels, which interferes with calcium metabolism and is therefore also a contributor to calcium loss.
  • Caffeine’s diuretic effect causes the loss of both water and calcium in the urine.
  • In adolescent girls, there is increased concern with body size and shape, and milk intake may well be avoided because it is considered fattening.
  • As menopause approaches, a loss of bone calcium accelerates because of the drop in oestrogen which is considered a bone protective hormone.

In general, studies highlight a troubling lack of knowledge as to the following facts:

  • the function of calcium
  • preventive aspects of calcium intake
  • sources of calcium
  • the recommended daily intake
  • when to take calcium supplementation for best absorption
  • the link between calcium levels and magnesium deficiency
  • the connection between menopause and calcium levels
  • the influence of alcohol use on calcium and Vitamin D levels
  • the importance of reducing calcium losses with a healthier lifestyle

Some possible solutions:

  • It is vital to develop intervention programmes which reach children, adolescents, teachers and mothers alike and inform them about how calcium consumption during childhood and adolescence must be developed to prevent the possibility of osteoporosis in later life.
  • Educational programmes should equally address insufficient awareness regarding the importance of reducing calcium losses.
  • It is important to establish what perceptions and concerns, other than poverty, influence calcium consumption among adolescents. Educational strategies can then be developed that translate the benefits demonstrated in clinical trials to adolescents in general. Negative attitudes and behaviours leading to low calcium intake can thus be dispelled.
  • Peer and family education programmes should ensure that stronger emphasis is placed on the negative effects of alcohol abuse in relation to sufficient calcium absorption.
  • The vital contribution of dairy products as part of a healthy diet should be widely instilled. Optimal use of milk, maas and yoghurt among consumers of all ages must be encouraged. Parents should ensure that drinking milk as a beverage becomes a lifelong habit for their children. Milk and yoghurt should be used more often in cooking.

The best solution of all, of course, is to value the bones in your body sufficiently to ensure commitment to an informed, calcium-rich, self-disciplined, active and healthy lifestyle.

NOFSA (National Osteoporosis Foundation South Africa)

NOFSA is the only non-profit, voluntary health organisation dedicated to promoting lifelong bone health. We focus on reducing the widespread prevalence of osteoporosis while working to find a cure for the disease, and by supporting research and developing programmes of education and advocacy.
Find out more about our work at: www.osteoporosis.org.za